Chapter 9
 Identify the major types of health care
information standards and the
organizations that develop or approve
them, including
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Messaging standards
Content and coding standards
Network standards
Standards for electronic data interchange
Electronic health record standards
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
Give examples of the four major methods by
which standards are developed—ad hoc, de
facto, government mandate, and consensus.
 Identify and discuss the role of organizations
that currently have a significant impact on the
adoption of health care information standards
in the United States.
 Discuss the relationships among health
information exchanges, regional health
information networks, and the Nationwide
Health Information Network.
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Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
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Standards Development Process
Standards that support Health Care
Information System Interoperability
 Classification, Vocabulary and Terminology
Standards
 Data Interchange Standards
 Health Record Content Standards

Federal Initiatives on Health Care IT
 Four Methods (Hammond & Cimino, 2001)
 Ad hoc—no formal adoption process
 De facto—vendor or other has a very large
segment of the market
 Government mandate
 Consensus—volunteers from organizations
come together to reach a formal agreement
 Organizations
 International Organization for
Standardization (ISO) www.iso.org
 American National Standards Institute (ANSI)
www.ansi.org
 Standards Development Organizations
(SDOs)
 ASTM International www.astm.org
 Health Level 7 www.hl7.org
 ANSI ASC X12 www.x12.org
 Facts
 Members are national standards bodies from
many countries
 ANSI is the US national body member
 Oversees the flow of documentation and
international approval of standards
developed by its member bodies
 Facts
 US member of ISO
 Accredits SDOs from a wide range of
industries (including health care)
 Oversees work of SDOs
 Does NOT develop standards
 Publishes the 10,000+ standards developed
by SDOs
 Facts
 Must be accredited by ANSI
 Develops standards in accordance with ANSI
criteria
 Can use the label “Approved American
National Standard”
 270+ ANSI-accredited SDOs representing
many industries, including health care
 To date no single vocabulary has
emerged
 Common coding and classification
systems
 ICD-9-CM (chapter 1)
 CPT (chapter 1)
 DRGs (chapter1)
National Committee on Vital and
Health Statistics identified a core set
of patient medical record information
(PMRI) terminology standards
 SNOMED CT
 LOINC
 Several federal drug terminologies including
RxNorm
 Systemized Nomenclature of
Medicine– Clinical Terms
 comprehensive clinical terminology developed specifically
to facilitate the electronic storage and retrieval of
detailed clinical information
 collaboration between the College of American
Pathologists (CAP) and the United Kingdom’s National
Health Service (NHS)

Logical Observation Identifiers Names and Codes
 Developed to facilitate the electronic transmission of
laboratory results
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Examples of Fully Specified LOINC Names
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Sodium:SCnc:Pt:Ser/Plas:Qn
Sodium:SCnc:Pt:Urine:Qn
Sodium:SRat:24H:Urine:Qn
Creatinine renal clearance:VRat:24H:Ur+Ser/Plas:Qn
Glucoseˆ2H post 100 g glucose PO:MCnc:Pt:Ser/Plas:Qn
Gentamicinˆtrough:MCnc:Pt:Ser/Plas:Qn
ABO group:Type:Pt:Bldˆdonor:Nom
Body temperature:Temp:8Hˆmax:XXX:Qn
Chief complaint:Find:Pt:ˆPatient:Nar:Reported
Physical findings:Find:Pt:Abdomen:Nar:Observed
Binocular distance:Len:Pt:Headˆfetus:Qn:US.measured
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UMLS Metathesaurus– all the common health
information vocabularies, including SNOMED CT,
ICD, and CPT, along with approximately 100 other
vocabularies
SPECIALIST Lexicon--contains information for many
terms, component words, and English language
words that do not appear in the metathesaurus
UMLS Semantic Network--contains information
about the categories to which metathesaurus
concepts are assigned and outlines relationships
among the categories
 Examples of Data Interchange
standards that impact health care
 Health Level 7 standards (HL7)
 Digital Imaging and Communications in
Medicine (DICOM)
 National Council for Prescription Drug
Programs (NCPDP)
 ANSI X12N standards
HL7 is an ANSI-accredited SDO
develops HL7 messaging standards to allow
interoperability among health care applications
 Involved in other standards activities, but the
messaging standard is referred to as HL7
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 American College of Radiology and the
National Electrical Manufacturers
Association published the first standard
in 1985
 Promotes communication of digital
image information regardless of device
manufacturer
 Works with picture archiving and
communications systems (PACS)
 ANSI accredited SDO
 Developed a standard for the
electronic submission of third
party drug claims
 X12N is the subcommittee of ASC X12
that deals with EDI for the insurance
industry
 The health care task group is TG2
 X12N/TG2 develops and maintains
standards for health care EDI
 Functional standards for
electronic health record content
 HL7 EHR Functional Model
 ASTM Healthcare Informatics
subcommittee’s Continuity of Care
(CCR) standard

Three
components
 Direct care
 Supportive
 Information
infrastructure
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The ASTM Continuity of Care Record (CCR) standard is
designed as a standard healthcare data summary.
Its purpose is to aggregate essential health care data
from multiple sources to provide an overall clinical
picture of a patient’s current and past health status.
It was developed jointly by ASTM International, the
Massachusetts Medical Society, the Healthcare
Information and Management Systems Society, the
American Academy of Family Physicians, the American
Academy of Pediatrics, and other health care
organizations.
 HIPAA
 CMS e-Prescribing
 ONC (Office of the National
Coordinator for Health Information
Technology)
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
 HIPAA electronic transaction standards
are primarily from ASC X12N
 HIPAA designated standard code sets
include
 ICD-9-CM
 CDT (Code on Dental Procedures and
Nomenclaure)
 HCPCS
 CPT-4
 HIPAA also identified designated
standards maintenance organizations to
develop, maintain, and modify relevant
EDI standards
 ACS X12
 Dental Content committee of the ADA
 HL7
 NCPDP
 NUBC
 NUCC
 Prescriber’s ability to electronically send
an accurate, error-free, and
understandable prescription directly to a
pharmacy for the point of care
 Mandate applies to Medicare Part D
transactions
 Formulary and benefit transactions
 Medication history transactions
 Fill status notifications
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
ONC identified two major goals (HHS, 2008).
Enable the transformation to higher quality, more
cost-efficient, patient-focused health care through
electronic health information access and use by care
providers, and by patients and their designees.
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Enable the appropriate, authorized, and timely
access and use of electronic health information to
benefit public health, biomedical research, quality
improvement, and emergency preparedness.

Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
Healthcare Information Technology Standards
Board (HITSP)– Purpose is to identify and
harmonize data and technical standards for
healthcare
 National Health Information Network (NHIN)-conceived as a “Network of Networks” to
provide a secure, nationwide, interoperable
infrastructure that will connect providers,
consumers, and others involved in supporting
health and health care
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Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
Health information exchange (HIE) refers to
the technology, standards, and governance
that enables the exchange of data between
the information systems of various health care
stakeholders
 A regional health information organization
(RHIO) is an organization that provides an HIE
to health care stakeholders in a specific region

Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
The NHIN is the technology, standards, and
governance that could connect all HIEs & RHIOs.
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
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Standards Development Process
Formal Standards Development Organizations
 ISO
 ANSI
 SDOs
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Classification, Vocabulary and Terminology
Standards
 SNOMED CT
 LOINC
 RxNorm
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Data Interchange Standards
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HL7
DICOM
NCPDP
ASC X12N
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Health Record Content Standards
 HL7 EHR Functional Model
 CCR
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Federal Initiatives for HIT
 HIPAA
 E-Prescribing
 ONC
 HITSP
 NHIN